Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Methods: Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. Results: Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). Conclusions Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To explore the role of one-to-one tutorial system combined with reflective teaching method in the teaching of clinical nurses in intensive care unit (ICU).Methods:A total of 21 nurses who practiced in ICU from March 2019 to October 2019 were set as the control group, and 21 nurses who practiced in ICU from December 2019 to July 2020 were set as a research group. The control group adopted traditional teaching, and the research group adopted the tutorial system combined with reflective teaching. The theoretical and technical performance assessment results, professional self-efficacy before and after teaching, and clinical comprehensive ability before and after teaching were compared between the two groups. SPSS 26.0 was used for t test χ2 test, and rank-sum test was used for rank distribution. Results:After teaching, there were significant differences between the two groups in the grades distribution of theoretical and technical operation examination results ( P<0.05). The excellent and good rate of theoretical and technical operation examination in the study group were higher than those in the control group ( P<0.05). Before teaching, there was no significant difference in the scores of job responsibility and education requirements in professional self-efficacy scale and clinical comprehensive ability (observation ability, communication ability, health education ability, humanistic care ability, emergency response ability, professional knowledge, accurate execution of doctor's advice and coordination ability with doctors) between the two groups ( P > 0.05). After teaching, the scores of professional self-efficacy scale and clinical comprehensive ability of nursing students in the two groups were significantly increased ( P<0.05). The scores of professional self-efficacy scale and comprehensive ability of nursing students in the study group after teaching were higher than those in the control group ( P<0.05). Conclusion:The application of one-to-one tutorial system combined with reflective teaching method can significantly improve the professional self-efficacy of nursing students, improve the teaching effect, and improve the clinical comprehensive quality of nursing students.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objective To evaluate the relationship between varicocele (VC) and the prostativenouplexuby coloDoppleflow imaging(CDFI) and to explore the etiology of varicocele .MethodThe innediameterand the hemorrheologiparameterof spermativein and prostativenouplexuwere observed in 135 patientwith lefvaricocele(lefVgroup) ,51 patientwith bilat-eral V(bilateral Vgroup) and the control group(100 cases) by CDFI .The diameteof the prostativenouplexus(PVD) ,peak velocity of reflux flow (RFV) in the Valsalvtesand the peak velocity of antegrade flow (AFV) aresin 3 groupwere statistical-ly analyzed .ResultPVD and RFV in the bilateral Vgroup were greatethan those in the lefVgroup and the control group (P＜0 .01) .PVD and RFV in the lefVgroup had no statistical differencecompared with the control group (P＞0 .05) .AFV had no statistical difference among 3 group(P>0 .05) .PVD ,RFV and AFV in 30 caseof Vhad no statistical differencebe-tween before and afteoperation (P>0 .05) .Conclusion Bilateral Vmay be accompanied with potential systematic vascular abnormalities.

Objective To investigate the prevalence of multidrug and multiple diseases in coronary heart disease in the hospitalized elderly patient.Methods Six hundred and twenty-two hospitalized coronary heart disease patients during 2008-2012 year were assigned to adult coronary heart disease group and they were divided into adults(18-64 years old) and elderly(≥65 years old) groups.Number of drugs was counted and number of diseases was counted based on diagnosis.Multidrug was defined as the kinds of concurrent drug use was over 5.Results The average kinds of drugs used in adult coronary heart disease group was (5.2 ± 3.4).The average kinds of drugs used in elderly coronary heart disease group was (11.2 ± 7.2).The average kinds of drugs in elderly coronary heart disease was higher than that of adult coronary heart disease (t =2.508,P ＜ 0.01).The average types of diseases in elderly coronary heart disease was higher than that of adult groups ((5.1 ±3.1) vs.(8.2 ±4.8),t =2.400,P ＜0.01).Conclusion Multidrug and multiple diseases are prevalent in the hospitalized coronary heart disease patient,and they are more prominent in elderly coronary heart disease patients.It is needed to further optimize the treatment.